Журнал "Медицинский совет" №21/2019

DOI: 10.21518/2079-701X-2019-21-58-64

И.А. Либов, e-mail: igor.libov@mail.ru
И.М. Майоров, e-mail: swimmajor@mail.ru
Л.П. Порунова, e-mail: lporunova@yandex.ru

Городская клиническая больница имени С.П. Боткина; 125284, Россия, Москва, 2-й Боткинский пр-д, д. 5

В статье обсуждаются вопросы, касающиеся лечения больных c персистирующей формой фибрилляции предсердий (ФП), анализируются показания к выполнению, при отсутствии эффекта от медикаментозного лечения, радиочастотной катетерной абляции (РЧА) устьев легочных вен и электрических спиральных волн в предсердиях или роторов, клинические эффекты этой процедуры, оценивается вклад фокусной активности в поддержание персистирующей ФП. Обсуждается вопрос влияния сопутствующей патологии и анатомо-морфологических особенностей сердца на ранние и отдаленные результаты РЧА у пациентов с персистирующей формой ФП.
Успех и эффективность хирургического лечения ФП зависят не только от метода и технологии выбранной процедуры, но и от факторов риска рецидива ФП (так называемых предикторов). Радиочастотная абляция, являясь инвазивным хирургическим вмешательством, имеет свой спектр возможных осложнений и высокую экономическую составляющую, что предопределяет необходимость прогнозирования эффективности процедуры, то есть дооперационного определения той группы пациентов, у которых данный вид лечения окажется оправданным, а предполагаемые эффективность и безопасность – выше вероятности осложнений. Изучение этой проблемы и разработка критериев отбора пациентов с ФП позволит с высокой вероятностью предсказывать эффективность оперативного вмешательства, что, в свою очередь, будет способствовать правильному выбору стратегии.

Для цитирования: Либов И.А., Майоров И.М., Порунова Л.П. Современные аспекты хирургического лечения больных с фибрилляцией предсердий. Разработка единых критериев для отбора пациентов на проведение радиочастотной абляции. Медицинский совет. 2019;(21):58-64. doi: 10.21518/2079-701X-2019-21-58-64.

Конфликт интересов: авторы заявляют об отсутствии конфликта интересов.

Modern aspects of surgical treatment of patients with atrial fibrillation. Development of uniform criteria for selecting patients for radiofrequency ablation

Igor’ A. Libov, e-mail: igor.libov@mail.ru
Igor’ M. Mayorov, e-mail: swimmajor@mail.ru
Lyudmila P. Porunova, e-mail: lporunova@yandex.ru

City Clinical Hospital named after S.P. Botkin; 5, 2nd Botkinsky Passage, Moscow, 125284, Russia

The article discusses the issues concerning the treatment of patients with the atrial fibrillation (AF), analyzes the indications for execution, in the absence of the effect of medication treatment, radiofrequency catheter ablation (RFA) of the lung vein entries and electrical spiral waves in the atria or rotors, the clinical effects of this procedure, assesses the contribution of focal activity in maintaining the persistent AF. The influence of concomitant pathology and anatomical-morphological peculiarities of the heart on early and distant RFA results in patients with persistent AF is discussed.
The success and efficacy of AF surgical treatment depends not only on the method and technology of the chosen procedure, but also on the risk factors for the recurrence of AF (so-called predictors). Radio-frequency ablation, being an invasive surgery, has its own spectrum of possible complications and high economic component, which predetermines the necessity to predict the efficiency of the procedure, i.e. preoperative determination of the patient group, in which this type of treatment will be justified, and the expected efficiency and safety – higher than the probability of complications. The study of this problem and the development of criteria for selecting patients with AF will allow predicting the effectiveness of surgical intervention with high probability, which in turn will contribute to the correct strategy selection.

For quotation: Libov I.A., Mayorov I.M., Porunova L.P. Modern aspects of surgical treatment of patients with atrial fibrillation. Development of uniform criteria for selection of patients for radiofrequency ablation. Meditsinskiy sovet = Medical Council. 2019;(21):58-64. (In Russ.) doi: 10.21518/2079-701X-2019-21-58-64.

Conflict of interest: the authors declare no conflict of interest.

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